Title Melanom - epidemiološka analiza
Title (english) Melanoma - epidemiological analysis
Author Sonja Kanđera
Mentor Biserka Pigac (mentor)
Committee member Jurica Veronek (predsjednik povjerenstva)
Committee member Biserka Pigac (član povjerenstva)
Committee member Melita Sajko (član povjerenstva)
Granter University North (University centre Varaždin) (Department of Nursing) Koprivnica
Defense date and country 2016-12-07, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Pathology
Abstract Melanom je jedan od najzloćudnijih tumora kože. Nastaje iz pigmentnih stanica
melanocita koji maligno alteriraju a imaju sklonost ranom limfogenom i hematogenom
metastaziranju. Čini oko 5 % svih primarnih zloćudnih tumora kože, ali je odgovoran za oko
80 % svih smrtnih slučajeva kožnih tumora. Godišnje povećanje oboljelih je oko 7 %. U
Republici Hrvatskoj godišnje se otkrije oko 580 novootkrivenih melanoma. Melanom nastaje
na nepromijenjenoj koži ili iz prekursorskih lezija. Najčešće se javlja na koži, no može se javiti
i na sluznicama, oku i u živčanom sustavu. Najveći maligni potencijal imaju divovski urođeni
i displastični nevusi. Melanom je najčešće tamne boje, od smeđe do crne, no može biti i bez
pigmenta. Melanom prolazi kroz tri faze rasta: melanoma in situ (faza pojave malignih
melanocita u epidermisa), radijalna faza (označava fazu lateralnog širenja) i vertikalna faza
(faza invazije dermisa). Prema kliničkim značajkama i histološkoj slici razlikujemo 4 najčešća
tipa: površinsko šireći melanom - SSM, nodularni melanom - NM, lentigo maligna melanom -
LMM i akralno lentiginozni melanom - ALM. Najčešći je površinsko šireći melanom s
najvećom pojavnošću na leđima u muškaraca i na donjim udovima u žena. Klinički znakovi
koji upućuju na sumnju na melanom su asimetričan oblik, nepravilni, nazubljeni ili izbrazdani
rubovi, boja koja može varirati od svijetlosmeđe do tamnosmeđe, veličine obično veće od 6
mm. Prognoza melanoma je primarno povezana sa debljinom tumora (Breslow), postojanjem
ulceracija te povećanim brojem mitoza. Prema relativnoj stopi petogodišnjeg preživljenja
prognoza za 0-stadij ima 97 %, I-stadij ima 90-95 % / 75 %, IIA-stadij ima 80 % / 65 %, IIBstadij
ima 72-75 % / 50-60 %, IIC-stadij ima 53 % / 44%, III-stadij ima 45 % a IV-stadij ima
10 % preživljenja. Kod udaljenih metastaza u IV stadiju ovisno o jednom ili više metastatskih
sijela stopa preživljenja u jednoj godini se smanjuje. Ostali nepovoljni prognostički čimbenici
su regresija dijela tumora, mikrosateliti, starija životna dob te muški spol. Terapija je uvijek
radikalna kirurgija, 1-3 cm u zdravo. Ako se u regionalnim limfnim čvorovima dokažu
metastaze, izvodi se i disekcija limfnih čvorova. Rana dijagnoza i edukacija ključ su uspješnog
liječenja melanoma. Osobe koje imaju melanom ili rakom kože opterećenu obiteljsku anamnezu
ili imaju displastični nevus sindrom (nakupine displastičnih nevusa) treba dermatološki
pregledavati najmanje jednom godišnje.
Abstract (english) Melanoma is one of the most malignant skin cancers. It begins in the skin's pigmentproducing
cells called melanocytes which undergo a malignant alteration and have tendency to
metastasize both lymphatic and hematogenous. Melanoma accounts for 5% of primary skin
cancers but is responsible for 80% of deaths from skin cancer. There are 580 new cases of
melanoma diagnosed in Croatia each year. Melanoma can arise from normal appearing skin or
in precursor lesions. It typically affects the skin but can also occur in mucous membranes, eyes
and the nervous system. Giant dysplastic nevi present at birth have a very high potential to
become malignant. The majority of melanomas are black or brown but can also be non
pigmented. There are three stages of melanoma: melanoma in situ (in this phase melanocytes
become malignant within the basal layer of the epidermis), the radial phase (considers the lateral
expansion) and the vertical growth phase (with invasion into dermis). According to the clinical
characteristics and histological picture there are 4 basic types of melanomas: superficial
spreading melanoma – SSM, nodular melanoma – NM, lentigo maligna melanoma – LMM, and
acral lentiginous melanoma – ALM. The most common is superficial spreading melanoma
which is most likely to occur on the back in men and the legs in women. Clinical signs that may
indicate melanoma are asymmetrical form, irregular, jagged or notched edges, colour that can
vary from light to dark brown and a size usually larger than 6 mm in diameter. The prognosis
for melanoma is closely related to tumor thickness, the presence of ulceration and the increase
in mitotic rate. The 5-year relative survival rate is as follows: stage 0 - 97%, stage I – 90-95%
/ 75%, stage IIA – 80% / 65%, stage IIB – 72-75% / 50 – 60%, stage IIC – 53% / 44%, stage
III – 45%, and stage IV – 10%. Depending on one or more distant metastases in stage IV, the
survival rate after one year declines. Other unfavourable prognostic factors are the presence of
regression, microsatellites, older age and male gender. Therapy is always radical surgery that
cuts 1 to 3 cm in healthy tissue. If regional lymph node metastases are detected, lymph node
dissection can be performed. Early detection of melanoma and education are keys to successful
treatment. Individuals who are diagnosed with melanoma or have a family history of melanoma
or dysplastic nevus syndrome (a large number of dysplastic nevi) should be dermatologically
checked at least once a year.
Keywords
melanom
patohistologija melanoma
sentinel limfni čvor
prevencija melanoma
prognoza melanoma
Keywords (english)
melanoma
pathohistology of melanoma
sentinel lymph node
melanoma prevention
prognosis for melanomas
Language croatian
URN:NBN urn:nbn:hr:122:554078
Study programme Title: Nursing Study programme type: professional Study level: undergraduate Academic / professional title: stručni/a prvostupnik/prvostupnica (baccalaureus/baccalaurea) sestrinstva (stručni/a prvostupnik/prvostupnica (baccalaureus/baccalaurea) sestrinstva)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2016-12-19 12:13:24